Long-term Outcome Of Catheter Ablation On Tachycardia-bradycardia Syndrome

Objectives:Tachycardia-bradycarcia syndrome(TBS)referring to sinus pauses(>3 s)at termination of atrial tachyarrhythmia[Atrial fibrillation(AF)],as a variant sick syndrome subtype,traditional treatment is implanted pacemaker therapy.With the rapid development and clinical application of catheter ablation technology,it has become the important method for the treatment of TBS patients,however the long-term outcome of catheter ablation in patients with TBS has not been elucidated.Methods:The 150 patients with TBS admitted in our hospital from 2002-2014 were reviewed in the present study.Patients with TBS who underwent catheter ablation were arranged into catheter ablation group(CA group),and patients who implanted pacemaker were arrange into pacemaker group(PM group).With respect to long-term clinical outcomes for 150 TBS patients,patients were followed clinically every 3 to 6 months,followed every half a year by outpatient follow-up and telephone follow-up.Following up a detailed symptom evaluation,a routine EKG,holter,pacemaker program,application of drugs,cardiovascular causes rehospitalization,clinical endpoint events and so on.At the end of the follow-up period(September 1,2016),compare sinus rhythm maintenance rate,stroke incidence rate,antiarrhythmic drug application rate,progression to persistent atrial fibrillation incidence and mortality rate between two groups,.Results:1.According to primary treatment,we classified the study population into CA group(n=79)and PM group(n=71).In the CA group,79 cases(female37),with an average age of(69.97 ±10.10).In the PM group,71 cases(female40),with a mean age of(71.75±9.33).2.Following up an average of 93 months(2-14years),CA group underwent1.2±0.5 procedures,70.9%patients maintained sinus rhythm without long pause,antiarrhythmic drug use ratio was 20.3%.While 8.5%patients in PM group maintained sinus rhythm,antiarrhythmic drug use ratio was 50.6%.The maintenance rate of sinus rhythm in CA group was significantly higher than that in PM group(70.9%vs 8.5%,P<0.01).The K-M survival curves was used in patients with sinus rhythm maintenance time between two groups,the sinus rhythm of CA group was always higher than that in PM group,Long-rank test shows P<0.001.10 patients(12.7%)in CA group underwent pacemaker implantation:all for recurrent TBS.The rate progression to persistent atrial fibrillation and operative complication were not significantly different.3.All causes of rehospitalization with cardiovascular were not significantly different between the two groups.The mortality was not significantly different between the two groups.4.The stroke incidence in CA group was lower than that in PM group(5.1%vs 15.4%,P<0.05).Conclusion:1.With long-term following up,catheter ablation could effectively eliminate both atrial-tachyarrhythmias and long pause for TBS without implanting pacemaker.Catheter ablation could improve sinus rhythm maintenance.2.All causes cardiovascular rehospitalization and mortality were not significant difference between two groups.3.The incidence of stroke in CA group was significantly lower than that in PM group.